Hospital staff members are blaming badly behaving doctors for low morale, stress, and high turnover, which contribute to medical mistakes, preventable complications, and even death, a recent study showed.
A survey of health care workers at 102 nonprofit hospitals from 2004 to 2007 found that 67 percent of respondents thought there was a link between disruptive behavior and medical mistakes, and 18 percent said they knew of a mistake that occurred because of a disruptive doctor. Dr. Alan Rosenstein, medical director for the West Coast region of VHA Inc., authored the study.
L. Silverthorn, a nurse in Washington, recounted a patient she knew was in danger; he had a shunt in his brain to drain fluid, but he was vomiting and had an extreme headache, two signs that the shunt was blocked and fluid was building up. She paged the on-call resident twice, receiving a response that she didn’t “know what to look for” because she’s “not a doctor.” After an ignored third page, she called the attending physician at home, who rushed the patient into surgery.
A survey by the Institute for Safe Medication Practices found that 40 percent of hospital staff members had been so intimidated by a doctor that they did not share their concerns about orders for medication that appeared to be incorrect. Consequently, 7 percent say they contributed to a medication error.
Abusive behavior by doctors has been decreasing in the past five to ten years, physicians and nurses report, though it is still a major problem. Some nurses say they have ducked scalpels thrown across the operating room, and more say they are insulted and yelled at, often in front of patients or other staff members. One-third of the nurses in Dr. Rosentein’s study knew of a nurse who had left a hospital because of a disruptive physician.
“Most people are trying to do the best job they can under a high-pressure situation,” said Dr. Joseph M. Heyman, chairman of the trustees of the American Medical Association. “About three to four percent of doctors are disruptive,” said Dr. William A. Norcross, director of a program at the University of California, San Diego, that offers anger management for physicians, “but that’s a big number, and they really gum up the works.”
The leading offenders of disruptive behavior are specialists in high-pressure fields such as neurosurgery, orthopedics, and cardiology. Dr. Peter B. Angood, chief patient safety officer at the Joint Commission, the nation’s leading independent hospital accreditation agency, witnessed an incident where a nurse called a surgeon to come verify his next patient and mark the operation spot. The surgeon yelled at the nurse to get the patient ready herself. The surgeon showed up late to the operating room, and wound up operating on the wrong part. The surgeon then “berated the entire team for their error . . . when the error was the surgeon’s because he failed to cooperate in the process,” Dr. Angood said. A hostile environment increases the risk of medical errors, said Dr. Angood. Dr. Norcross blames the training surgeons get. “That whole structure teaches a disruptive behavior.”
Things may be changing for the better. Two of the six core skills taught in medical schools and residency programs are good communication and leadership. Hospitals are also either “getting rid of [disruptive] doctors, or sending them to anger management,” noted D. Thomas R. Russell, executive director of the American College of Surgeons.
collaboration and communication between fields. Ms. Silverthorn says the changes are overdue, a view most other staff members agree with. “We go to school, we have a very important job, but there’s no respect.”